전교통 동맥류의 특징적인 혈관 조영 소견 - 디지털감산 혈관조영술을 통한 재평가

Abstract

Background and Purpose : Understanding of the morphology and direction of the anterior communicating artery aneurysm is important in the appropriate management of this disorder. The purpose of our study is to analyze and reassess the angiographic findings of anterior communicating artery aneurysms. Materials and Methods : We retrospectively reviewed cerebral angiography in 90 patients with anterior communicating artery aneurysm among 272 patients with cerebral aneurysm from Jan. 1994 to Dec. 1995. There were 44 men and 46 women. Their age ranged from 22 years to 79 years (mean: male 46 years, female 60 years). We analyzed the size and shape of the aneurysms. The shape of the aneurysms was divided into saccular, bi- or multilobulated, elongated, dumbbell and sessile. The projection of fundus was categorized to anterior, superior, posterior, inferior based on the lateral view. The dominant contrast filling of aneurysm in both internal carotid angiogram was determined by the anterio-posterior view of the carotid angiogram. The asymmetry of A1 segment was classified as ipsilateral A1 enlargement, contralateral A1 aplasia, hypoplasia, and symmetry. Results : The size of anterior communicating artery aneurysms ranged between 3 and 6㎜in diameter in 41 patients, and between 7 and 10㎜in diameter in 23 patients. Sixty-two of 90 anterior communicating artery aneurysms were of left-sided dominant contrast filling, and 28 of 90 were right-sided. Sixty-six of 90 aneurysms were saccular, 8 were elongated, 7 were bi- or multilobulated, 6 were dumbbell, and 3 were sessile in shape. The fundus of anterior communicating artery aneurysms was projected to anterior in 34, superior in 25, inferior in 20, and posterior in 8 patients. The asymmetry of A1 segment of anterior cerebral artery was as follows; ipsilateral A1 enlargement in 48(53%), contralateral A1 aplasia in 26(29%), while 14 did not show asymmetry. Conclusion : Most of the anterior communicating artery aneurysms are <10㎜in diameter and saccular in shape with anterior and superior direction to the A1 segment. Analysis of angiographic findings of aneurysms would be helpful in the decision of proper treatment. Korean Journal of Stroke 1999;1(1):59~64